Abstract
BackgroundAccurate diagnosis of urinary tract infection is essential as children left untreated may suffer permanent renal injury.AimTo compare the diagnostic values of biomarkers or clinical prediction rules for urinary tract infections in children presenting to ambulatory care.Design and settingSystematic review and meta-analysis of ambulatory care studies.MethodsMedline, Embase, WOS, CINAHL, Cochrane library, HTA and DARE were searched until 21 May 2021. We included diagnostic studies on urine or blood biomarkers for cystitis or pyelonephritis in children below 18 years of age. We calculated sensitivity, specificity and likelihood ratios. Data were pooled using a bivariate random effects model and a Hierarchical Summary Receiver Operating Characteristic analysis.ResultsSeventy-five moderate to high quality studies were included in this review and 54 articles in the meta-analyses. The area under the receiver-operating-characteristics curve to diagnose cystitis was 0.75 (95%CI 0.62 to 0.83, n = 9) for C-reactive protein, 0.71 (95% CI 0.62 to 0.80, n = 4) for procalcitonin, 0.93 (95% CI 0.91 to 0.96, n = 22) for the dipstick test (nitrite or leukocyte esterase ≥trace), 0.94 (95% CI 0.58 to 0.98, n = 9) for urine white blood cells and 0.98 (95% CI 0.92 to 0.99, n = 12) for Gram-stained bacteria. For pyelonephritis, C-reactive protein < 20 mg/l had LR- of 0.10 (95%CI 0.04–0.30) to 0.22 (95%CI 0.09–0.54) in children with signs suggestive of urinary tract infection.ConclusionsClinical prediction rules including the dipstick test biomarkers can support family physicians while awaiting urine culture results. CRP and PCT have low accuracy for cystitis, but might be useful for pyelonephritis.
Highlights
Paediatric urinary tract infections (UTI) could be considered serious since they may trigger systemic infection and result in kidney scarring [1]
The area under the receiver-operating-characteristics curve to diagnose cystitis was 0.75 (95%CI 0.62 to 0.83, n = 9) for C-reactive protein, 0.71 for procalcitonin, 0.93 for the dipstick test, 0.94 for urine white blood cells and 0.98 for Gram-stained bacteria
UTIs occur in nearly 6% of all acutely ill children presenting to ambulatory care [2]
Summary
Paediatric urinary tract infections (UTI) could be considered serious since they may trigger systemic infection and result in kidney scarring [1]. UTIs occur in nearly 6% of all acutely ill children presenting to ambulatory care [2]. Prompt diagnosis and treatment is vital to prevent. Rapid urine tests might improve early diagnosis and might reduce the use of ineffective antibiotics [6]. Two other systematic reviews have been published on the diagnostic accuracy of urine biomarkers for UTIs in children [7, 8]. No single rapid urine test was found that could replace urine culture. Accurate diagnosis of urinary tract infection is essential as children left untreated may suffer permanent renal injury
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
